AHS Releases Updated Cluster Headache Guidelines

The American Headache Society has released new guidelines for the treatment of acute cluster headache (CH), an update to the 2010 American Academy of Neurology systematic review.

CH is the most common trigeminal autonomic cephalalgia, and is often not optimally treated. In order to assist clinicians with identifying and selecting current treatment options, the researchers conducted a systematic review of available evidence for the acute and prophylactic treatment of CH.
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They found that for acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high-flow oxygen remain the only treatments with a Level A recommendation. Sphenopalatine ganglion stimulation, previously absent from the 2010 review, was added as a Level B recommendation for acute treatment.

For prophylactic therapy, suboccipital steroid injections were added as the only Level A treatment recommendation, while deep brain stimulation was given a Level B recommendation, warfarin, cimetidine/chlorpheniramine, and candesartan were given a Level C recommendation, and frovatriptan was given and Level U recommendation.

“Other emerging therapies for the treatment of CH that are under active investigation include monoclonal antibodies to calcitonin gene-related peptide and other forms of neurostimulation with more refined methodology aimed at reducing procedure-related adverse events,” the authors concluded.

“In the meantime, this guideline, based upon the level of evidence that treatments are effective, can be considered along with other variables when making treatment recommendations for patients with episodic and chronic CH.”

—Michael Potts

Reference:

Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ. Treatment of cluster headache: the American Headache Society evidence-based guidelines. Headache. 2016;56(7):1093-1106.